1. Delta Dental of Kansas Community Benefit Program
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Delta Dental of Kansas Community Benefit Program 1

2. Benefit Plan Details
DDKS is covering up to $3,000 in dental claims.  Any treatment/claims over the $3,000 annual maximum will be the responsibility of the dental office and/or patient.
100% Diagnostic and Preventive, 100% Basic, 100% Major coverage
$3,000 annual maximum
$5.00 per person/$10.00 per family yearly deductible
Patients can visit ANY in-network Delta Dental provider.
Waiting periods waived
Frequencies and limitations are waived on all services, including Diagnostic & Preventive services
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3. Benefit Plan Details
Diagnostic & Preventive services will count towards the annual maximum.
Dependents covered up to age 26
12 month program (i.e. if an individual is eligible in November 2019, they will have coverage until November 2020)
Individuals are eligible for coverage for 2 years, but United Way will verify eligibility requirements on an annual basis.
Not covered: braces (orthodontics), TMJ, cosmetic, implants, harmful habit appliances, occlusal guards or out of country claims
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5. What are the eligibility requirements?
Families with income less than or equal to 250% of the federal poverty line.
Head of household must be employed.
Family members do not have access to dental insurance by more traditional means, e.g., employer, eligibility as a dependent, state of residence.
Those enrolled in governmental dental programs are eligible for enrollment.
Year Two:
Renewal coverage applicants must meet criteria listed above and must have utilized the program by at least one family member during the prior year.
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As you think of individuals for this program, look for individuals
who are in need of dental care. 5

6. How do individuals enroll?
Fill out the Enrollment Form, the Consent to Release Information Form and the Agency Confirmation Form
Via at
Via fax to ; attention Dental
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7. What happens next?
United Way will verify eligibility and notify the agency contact of approval/denial. If approved, the eligibility date will be provided along with a Welcome Brochure that may be printed and provided to the individual.
The agency contact will then notify the individual of approval/denial.
The approved individual will receive a Delta Dental ID Card in the mail.
Once eligible, the individual(s) may visit the dentist.
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8. Helping You Educate https://deltadentalks.co m/groups/united-way
DeltaDentalKS.com/UnitedWay
m/groups/united-way

9. Questions? 9